As the afternoon light fades, something changes. The person who was calm and engaged during the day becomes restless, confused, or agitated. They may pace, refuse care, say they need to go home — even when they’re already home.
This is sundowning. With the right strategies, many families can manage it.
What causes sundowning?
Sundowning is believed to involve disruption to the circadian rhythm. Contributing factors include fatigue accumulating over the day, reduced light and visual cues that help with orientation, hunger, pain, or physical discomfort, overstimulation during the day, and underlying infections (UTIs are a particular trigger for sudden behavioral changes).
Strategies that help
Maximize light exposure earlier in the day. Natural light in the morning and early afternoon helps regulate the circadian rhythm.
Structure the late afternoon. The period between 3pm and 6pm is the highest-risk window. plan calm, familiar activities — looking through family photos, listening to familiar music.
Reduce environmental triggers. Dim harsh overhead lighting. Reduce noise and visual clutter.
Watch for physical triggers first. Before attributing agitation to sundowning, rule out pain, hunger, thirst, a full bladder, or UTI.
Don’t argue with the reality. Acknowledge the feeling: “It sounds like you want to be somewhere comfortable. Let’s sit together for a bit.”
Establish a calming evening routine. Consistent evening rituals signal to the brain that the day is winding down.
When sundowning requires additional support
This is a common inflection point where families bring in additional help — a caregiver to handle the late-afternoon and evening hours, providing a patient, trained presence during the hardest part of the day.
Talk to us about evening care options — including what coverage may be available through Medi-Cal.